Dermatology Referral Not Needed for HealthSelect of Texas^®

Effective Jan. 1, 2025, HealthSelect of Texas In‑Area medical plans no longer require participants to get a referral from their primary care providers to obtain services from in‑network dermatologists.

Remind Billing Agencies to Correctly Submit Claim Review Requests

Agencies may submit requests using our claim review form or, for faster processing, submit requests electronically through Availity^® Essentials. Learn tips on how to complete submissions and avoid returned requests.

ClaimsXten^TM Quarterly Update

We’ll implement first quarter code updates for the ClaimsXten auditing tool on or after March 17, 2025.

Medical Records Needed to Support Quality Care

You may receive requests in 2025 for our members’ medical records. We collect data for Healthcare Effectiveness Data and Information Set (HEDIS^®) measures to track quality of care. Learn how you can help by promptly providing complete records for these members:

• Federal Employee Program^®

• Medicaid

• Medicare Advantage

Follow‑Up Care Is Recommended for Children Prescribed ADHD Medication

Attention‑deficit/hyperactivity disorder is one of the most common behavioral health disorders affecting children. To support quality care, we gather data on follow‑up visits for children using ADHD medication.

Remind Our Members About Cervical and Breast Cancer Screenings

Regular screening tests can help detect cancer early when it’s easier to treat. Learn about documenting these screenings in members’ medical records and other tips to close gaps in care.

Accurate Category II Codes May Help Identify Gaps in Care

Using the proper Current Procedural Terminology (CPT^®) Category II codes on claims can help streamline your administrative processes and ensure gaps in care are closed. We developed a coding reference for several quality measures that you can access in Availity Essentials.

Review Member Satisfaction Survey Results

Survey results from 2023 reflect areas of improvement and where you may have the most impact on members’ experiences. Our next survey starts in February 2025.

New Gene Therapy Solutions Helps Monitor Results

We launched gene therapy solutions on Jan. 1, 2025, to support access to care while protecting against high treatment costs for our commercial group members. To help track clinical outcomes, we may ask you for information about the effectiveness of gene therapy treatments prescribed for our members.

Explore Learning Opportunities

We offer free webinars and workshops for providers who participate in our networks. Webinars include training on electronic tools and courses that offer continuing education credit. For new providers and staff, we offer orientation and reference materials.

Stay Updated on Medicaid News

You can find information for STAR, STAR Kids and CHIP on our Medicaid News and Updates page.

Funds to Be Recouped on Some Medicare Advantage Hospital and Ancillary Claims

We recently identified that some Medicare Advantage claims were paid incorrectly to hospitals and ancillary providers. You’ll receive a letter if you have any impacted claims. Learn more about our recoupment process.

New Part D Quality Measures Track High‑Risk Medication Combinations

The Centers for Medicare & Medicaid Services added two quality measures to its Star Ratings for Medicare prescription drug plans. Learn more about the measures and the risks of concurrent use.

Update Your Records for New Members of Blue Cross Group Medicare Advantage Open Access (PPO)^SM

New Medicare‑eligible retirees have joined our Blue Cross Group Medicare Advantage Open Access (PPO) plan for retirees of employer groups. If you’re a Medicare provider, you may treat these members even if you don’t participate in our Medicare Advantage or other networks.

Ensure Your Office Is Providing Your Most Current Information

When seeking care, our members may contact your office or search our online Provider Finder^® for information such as your appointment availability for new patients. Learn how to ensure our members can access the most up‑to‑date information.

Keep Your Contact Information Updated to Receive Recredentialing Reminders

Providers credentialed with us are required to recredential every three years. Keep your information updated with us and the Council for Affordable Quality Healthcare to receive reminders and ensure we’re able to obtain your recredentialing application with CAQH.

Preferred Drugs to Be Recommended Through Enhanced Prior Authorization

When submitting prior authorization requests for certain drugs beginning Jan. 1, 2025, you’ll receive recommendations for comparable preferred drugs. This process can improve access to more affordable care for some of our commercial and individual members.

Lab Management Clinical Payment and Coding Policies Updated for Certain Administrative Services Only Groups

Some reimbursement policies are updated with newly published American Medical Association procedure codes, effective Jan. 1, 2025.

Clinical Payment and Coding Policy Updates

We periodically add and modify Clinical Payment and Coding Policies as part of our ongoing policy review. These policies provide billing, coding and documentation guidelines. Visit our CPCP page regularly to ensure you’re up to date on any changes or new policies.